scholarly journals Low erythropoietin levels predict faster renal function decline in diabetic patients with anemia: a prospective cohort study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yohei Fujita ◽  
Yohei Doi ◽  
Takayuki Hamano ◽  
Masahiro Hatazaki ◽  
Yutaka Umayahara ◽  
...  
Keyword(s):  
Renal Function ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Iron Status ◽  
Renal Outcome ◽  
Diabetic Patients ◽  
Epo Deficiency ◽  
Egfr Decline ◽  
Egfr Slope

Abstract Elevated erythropoietin (EPO) levels have been reported to predict poor survival in various populations including diabetic patients. However, data regarding its impact on renal outcomes are scarce. We conducted a single-center, prospective cohort study of 339 type 2 diabetic patients with anemia. The primary outcome was the estimated glomerular filtration rate (eGFR) slope for two years. We performed multiple linear regression and restricted cubic spline analyses to assess the association of serum EPO levels with the renal outcome. Chronic kidney disease (CKD) was defined as eGFR <60 mL/min/1.73 m2 or urine albumin-to-creatinine ratio >30 mg/g creatinine. Median baseline EPO and eGFR level were 14.4 IU/L and 53 mL/min/1.73 m2, respectively. Inappropriately low EPO levels were observed in 73% of anemic patients and 59% of anemic patients even without CKD, suggesting that EPO deficiency precedes the onset of CKD in diabetes mellitus. Multivariable analysis revealed that iron status and hemoglobin levels were major determinants of EPO levels. Median eGFR slope was −1.3 mL/min/1.73 m2/year. We found that low EPO levels, but not low hemoglobin levels, were associated with a faster decline in eGFR, independent of clinically relevant factors. The eGFR decline was steeper, particularly when the EPO level was below the upper limit of normal. Lower EPO concentrations were associated with rapid eGFR decline, especially in patients with iron deficiency (P for interaction = 0.01). Relative EPO deficiency should be considered as a culprit in anemia of unknown etiology in diabetic patients, even those without CKD. Low EPO levels, especially when accompanied by poor iron status, are predictive of rapid loss of renal function.

scholarly journals Serum hepcidin and iron status parameters in pregnant women and the association with adverse maternal and fetal outcomes: a study protocol for a prospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032280
Author(s):  
Gabriela Amstad Bencaiova ◽  
Deborah Ruth Vogt ◽  
Irene Hoesli
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Gestational Hypertension ◽  
Smoking Status ◽  
Iron Status ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Serum Hepcidin

IntroductionHepcidin production is normally upregulated by iron stores, and in obesity has been shown to be overexpressed and correlated with low iron status. The increased hepcidin may restrain the iron release from the cells by affecting the expression of ferroportin, which probably associates with the development of diabetes complication. First, we investigate the difference of serum hepcidin and iron parameters between obese and non-obese pregnant women; second, we examine the correlation between serum hepcidin and adverse maternal and neonatal outcomes in pregnant women.Methods and analysisThis is a mono-centre, prospective cohort study with a study (obese) and a control group (non-obese women). In the first trimester, 188 singleton pregnancies will be recruited. Thereof, we expect 75 with a body mass index (BMI) ≥30 kg/m2and 113 with a BMI 18.5–30 kg/m2. Serum hepcidin, iron and haematological parameters will be measured at 11–14, 24–28, 32–36 weeks of gestation and at time of delivery. Blood pressure, weight, BMI and smoking status will be examined at all visits. We will assess the composite endpoints adverse maternal outcomes (including pre-eclampsia, gestational hypertension, gestational diabetes mellitus, haemorrhage, placenta abruption) and adverse neonatal outcomes (preterm birth, intrauterine growth restriction, preterm premature rupture of membranes, Apgar score <7 at 5 min, stillbirth, neonatal death).Recruitment has started in April 2019.Ethics and disseminationThis study received ethical approval from the ethics committee in Basel. The results of the study will be published in a peer-reviewed journal, and presented at national scientific conferences.Trial registration numberNCT03792464.

scholarly journals Epidemiological correlates with communicable viral co-infections of hepatitis B and hepatitis C and non-communicable diabetes among HIV ART naïve rural patients of Kanchipuram district: a prospective cohort study

2018 ◽  
Vol 5 (8) ◽  
pp. 3283
Author(s):  
A. Kasthuri ◽  
K. Mohana Krishnan ◽  
S. K. Amsavathani
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hepatitis C ◽  
Hepatitis B ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Onset Of Diabetes

Background: The objectives of the study were to study the epidemiological correlates of ART Naïve HIV cases; to study the incidence of co–infections among them; to find the incidence of onset of diabetes among them. Concomitant infection of hepatitis B virus, hepatitis C virus viruses leads to higher frequency of carrier state and severe manifestations of the disease in HIV patients. There is general agreement that the traditional risk factors for DM (increasing age, minority race, obesity) are still responsible for most of the increased risk in the HIV infected population.Methods: This study was designed as a prospective cohort study and was done at the Meenakshi Medical College & Research institute, an academic and Tertiary medical centre in Kanchipuram, Tamil Nadu, South India. The study duration was from June 2004 to June 2010. SPSS 13 was used in the calculation of chi-square and percentages.Results: Among 207 participants, mean age is 36.04 and the SD is 10.895. There is significant difference between the incidence of viral co-infections like hepatitis B and hepatitis C (p<0.001). There is significant difference between the incidence of onset of diabetes (p<0.001). The HbsAg and HCV co infection was comparatively lower than the urban population. Among the 50 HIV reactive, non diabetic patients without risk factors, only one found to be Diabetic and another found to be Pre diabetic after 6 months follow-up.Conclusions: The cost of treatment escalates, when PLHA is co-infected either with viral infections or diabetes, and also their quality of life becomes poor. So, monitoring of CD4 and CD8 should be done as a routine and screening and early treatment should be made mandatory. 

scholarly journals Relevance of Screening for Urinary Tract Infection in Well Infants with Prolonged Jaundice: A Prospective Cohort Study

2019 ◽  
Vol 25 (1) ◽  
pp. 13-18
Author(s):  
Caroline Siew Yin Eng ◽  
Thalitha Vijayakulasingam ◽  
Boon Hong Ng ◽  
Maryam Jamilah Surdi Roslan ◽  
Muhammad Zamakhshari Zainal Abidin ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Cohort Study ◽  
Urinary Tract ◽  
Tract Infection ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Unit Cost ◽  
Renal Outcome ◽  
Term Infants ◽  
Prolonged Jaundice

Background:  Recent retrospective studies suggest irrelevance of urine screening for neonate with prolonged jaundice. We re-evaluated the incidence of urinary tract infection (UTI) among these infants, their renal outcome and evaluated the cost incurred. Methods: This is a prospective cohort study. Asymptomatic, prolonged jaundiced infants with unconjugated hyperbilirubinemia were screened for evidence of UTI as per local guidelines. Infants with pyuria would have urine sent for culture and sensitivity. Unit cost was referenced from hospital purchase. Statistical analysis was performed using SPSS 24.0.  Results: A total of 291 cases were analyzed. Majority were term infants (93.8%). The commonest cause of prolonged jaundice was breast milk jaundice, hence an incidence rate of 0.34%. Only one infant persistently showed single uropathogen on urinary culture with concurrent pyuria. Urinary structures were normal on ultrasonography and there was no evidence of renal cortical scarring. No recurrence of UTI documented in the first year of life. Each “clean-catch” urinalysis costed RM7. This unit cost escalated to RM37 for catheterized sample.  A negative urine culture costed RM28 while a positive culture twice this price. The average cost effectiveness ratio (ACER) in this study was RM5856.56 per detection of case.    Conclusion: Incidence of UTI is low. In our study, an undesirable outcome is negligible. Unnecessary parental anxiety from the potentially laborious procedure could be avoided. This study refutes previous literature to include such screening in prolonged jaundice as this may well be irrelevant.

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